Coding for more than 10 antepartum visits

Q One of our providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q One of our providers (a midwife) had 13 antepartum visits with a patient, only to have the patient require a cesarean. I know 59426 covers 7 or more visits, but with 13, should we submit the related notes with a paper claim?

A The code 59426 is used for any number of antepartum visits equaling 7 or more, so the midwife’s care will indeed fall under this code definition. However, you might be interested to know that the code was valued under the Medicare resource-based relative value scale system on the assumption that the average number of visits would be 10 (1 initial and 9 subsequent antepartum visits). If the midwife documented significant additional work due to developing complications at the end of the pregnancy, adding modifier-22 (unusual services) may be appropriate.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.